Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sci-ences, University at Buffalo, State Univ-ersity of New York, Buffalo, New York.
Department of Neurosurgery/Gates Vas-cular Institute, Buffalo General Medical Center, Kaleida Health, Buffalo, New York.
Neurosurgery. 2018 Apr 1;82(4):548-554. doi: 10.1093/neuros/nyx211.
Surgical site infections (SSIs) are noteworthy and costly complications. New recommendations from a national organization have urged the elimination of traditional surgeon's caps (surgical skull caps) and mandated the use of bouffant caps to prevent SSIs.
To report SSI rates for >15 000 class I (clean) surgical procedures 13 mo before and 13 mo after surgical skull caps were banned at a single site with 25 operating rooms.
SSI data were acquired from hospital infection control monthly summary reports from January 2014 to March 2016. Based on a change in hospital policy mandating obligatory use of bouffant caps since February 2015, data were categorized into nonbouffant and bouffant groups. Monthly and cumulative infection rates for 13 mo before (7513 patients) and 13 mo after (8446 patients) the policy implementation were collected and analyzed for the groups, respectively.
An overall increase of 0.07% (0.77%-0.84%) in the cumulative rate of SSI in all class I operating room cases and of 0.03% (0.79%-0.82%) in the cumulative rate of SSI in all spinal procedures was noted. However, neither increase reached statistical significance (P > .05). The cumulative rate of SSI in neurosurgery craniotomy/craniectomy cases decreased from 0.95% to 0.75%; this was also not statistically significant (P = 1.00).
National efforts at improving healthcare performance are laudable but need to be evidence based. Guidelines, especially when applied in a mandatory fashion, should be assessed for effectiveness. In this large, single-center series of patients undergoing class I surgical procedures, elimination of the traditional surgeon's cap did not reduce infection rates.
手术部位感染（SSI）是值得关注且代价高昂的并发症。一个国家组织提出了新的建议，敦促消除传统的外科医生帽（手术帽），并要求使用头巾帽来预防 SSI。
报告在一个拥有 25 间手术室的单一地点，在禁止使用外科帽 13 个月后，超过 15000 例 I 类（清洁）手术的 SSI 发生率。
从 2014 年 1 月至 2016 年 3 月的医院感染控制每月汇总报告中获取 SSI 数据。根据自 2015 年 2 月以来医院政策的变化，要求强制性使用头巾帽，数据分为非头巾帽和头巾帽两组。收集并分析了政策实施前 13 个月（7513 例患者）和实施后 13 个月（8446 例患者）两组的每月和累积感染率。
所有 I 类手术室病例的累积 SSI 发生率总体增加了 0.07%（0.77%-0.84%），所有脊柱手术的累积 SSI 发生率增加了 0.03%（0.79%-0.82%）。但这两种增加均未达到统计学意义（P >.05）。神经外科开颅/颅骨切除术病例的 SSI 累积率从 0.95%降至 0.75%；这也没有统计学意义（P = 1.00）。
提高医疗保健绩效的国家努力值得称赞，但需要基于证据。特别是当以强制性方式应用指南时，应评估其有效性。在这项涉及接受 I 类手术的大量单一中心患者的研究中，消除传统的外科医生帽并未降低感染率。
